Here are 2 main types of health insurance in Canada:

Public Health Insurance in Canada (Medicare)

Overview of Canada’s Medicare System

Medicare is the unofficial name for Canada’s universal healthcare system. It is a publicly funded insurance program that provides basic medical and hospital care to all Canadian citizens and permanent residents.

Key facts about Medicare:

• • Administered and delivered by provincial and territorial governments

• • Funded through taxes

• • Regulations set federally through the Canada Health Act

• • Covers medically necessary care, including doctor visits, hospitalizations, surgeries, diagnostic testing

Canadians access Medicare using their provincial or territorial health card. The extent of coverage varies between provinces.

Eligibility Requirements for Medicare

To be eligible for Medicare coverage, you must be a resident of the province or territory where you seek medical services. Each province/territory sets its own residency requirements, but generally you must:

• • Be a Canadian citizen or permanent resident

• • Physically live in the province/territory for a minimum of 3 months

• • Apply and be approved for a provincial/territorial health card

New residents coming from other parts of Canada can continue using their existing health cards for a grace period while establishing residency.

Services Covered Under Medicare

Medicare covers all medically necessary hospital, physician, and diagnostic services. This includes:

• • Doctor visits and specialist appointments

• • Emergency room visits

• • Standard hospital accommodations

• • Diagnostic tests (x-rays, MRIs, CT scans)

• • Surgeries and transplant operations

• • Childbirth and maternity care

• • Chronic disease management

Coverage for supplemental services like prescription drugs, mental healthcare, dental, and vision varies between provinces. Many provide limited coverage or income-based assistance programs for groups like seniors and low-income households.

Exclusions and Limitations of Medicare

While Medicare provides essential medical coverage, significant gaps exist:

Prescription medications – Universal coverage for prescription drugs is not included in the Canada Health Act. Some provinces offer limited plans or catastrophic coverage.

Dental – Routine dental care is not covered. Some provinces cover certain surgical and dental procedures in hospitals.

Vision – Eye exams are covered for minors and seniors only in some provinces. Glasses and contacts are not covered.

Mental health – Limited public coverage exists for mental health services. Long-term therapy is often excluded or comes with visit limits.

Ambulance services – Emergency ambulance transportation is not always covered. Fees vary greatly across provinces.

Devices and supplies – Orthotics, crutches, braces, and diabetic supplies generally require private insurance or out-of-pocket payment.

Home care and long-term care – Limited coverage for in-home nursing care, long-term care homes, and residences for seniors.

Private Health Insurance in Canada

Canadians can supplement gaps in Medicare coverage through private health insurance plans. These are offered by private insurance companies on an individual or group basis.

Private health insurance refers to plans offered by private companies to help cover medical costs not fully covered under provincial health plans. Here’s a quick overview:

• • Provides supplemental coverage beyond public health insurance

• • Helps pay for prescription drugs, dental, vision, therapy, medical devices, and more

• • Offered through individual plans or employer group plans

• • Requires paying monthly or annual premiums to maintain coverage

• • Level of coverage and price point varies between plans

When you visit a healthcare provider, you show both your provincial health card and private insurance card. Your private insurer reimburses you for eligible expenses based on your policy details. Having private coverage reduces out-of-pocket costs.

Supplemental Health Insurance Plans

Over two-thirds of Canadians have some form of supplementary health coverage to expand their benefits beyond Medicare:

• • Extended health plans – Also called supplementary or enhanced plans. Help cover drugs, dental, vision, paramedical therapies, medical devices, and more. Can be purchased privately or accessed through workplace group plans.

• • Travel medical insurance – Provides emergency medical coverage when travelling outside your home province or country. Protects against unexpected costs arising from injury, illness, or accidents abroad.

• • Critical illness insurance – Provides a lump-sum cash payment upon diagnosis of a specified critical illness to cover expenses related to treatment, recovery, and time off work.

• • Long-term care insurance – Covers home care, nursing, facility care, and other long-term care services for those unable to care for themselves due to old age, chronic illness, or disability. Helps pay costs not covered under Medicare.

Key Statistics on Private Health Insurance

• • Percentage of Canadians with supplementary health insurance: 67%

• • Percentage with insurance through workplace plans: 90%

• • Average household spending on private health premiums per year: $4000

• • Average per-person expenditure on uninsured health services per year: $902

Top reasons for claims through private health insurance:

• • Prescription drugs: $13.4 billion

• • Dental: $9.5 billion

• • Hospital accommodations: $1.6 billion

• • Vision: $1.3 billion

• • Paramedical: $1.1 billion

Benefits of Private Health Insurance

Private health plans provide Canadians with expanded options, flexibility, and financial protection:

• • Covers services excluded or only partially covered under Medicare

• • Choice in selecting desired level of coverage

• • Access to supplementary services like dental, prescription drugs, physiotherapy

• • Coverage for medical care abroad through travel health insurance

• • Reduces financial burden when faced with injury, illness, or emergency

Canadians spend over $30 billion annually on health costs not covered under Medicare. Private insurance helps make these expenses more manageable.

Read more : Compare Public vs. Private Health Insurance in Canada